Cigarette smoking and completed suicide: Results from 3 prospective cohorts of American adults
Open accessAbstract
Background Prior reports have indicated a potential dose-response relationship between smoking and suicide. However, this relationship is controversial.Methods This study evaluated the association between smoking and risk of death from suicide in three large-scale cohorts of U.S. men and women (n=253,033). Suicides were identified from death certificates among 43,816 men enrolled in the Health Professionals Follow-up Study (HPFS) between 1986 and 2008, 116,566 women in the Nurses' Health Study (NHS) between 1976 and 2008, and 92,651 women in the NHS II between 1989 and 2007. Information on smoking was obtained at baseline and updated every 2 years. Relative risks (RRs) of suicide were estimated using Cox proportional hazards regression models. Cohort specific RRs were pooled using random-effects models. Suicide deaths were determined by physician review of death certificates.Results A total of 457 deaths from suicide were documented. Compared to never smokers, the pooled multivariate RR (95% confidence interval [CI]) of suicide was 1.15 (0.91-1.45) for former smokers and 2.69 (2.11-3.42) for current smokers. A nonmonotonic dose-response relationship was noted between the number of cigarettes smoked per day (CPD) and suicide risk (P trend<0.001). Compared to never smokers, the pooled multivariate RR (95% CI) was 2.59 (1.77-3.79) for those with 1-14 CPD, 2.03 (1.39-2.94) for those with 15-24 CPD, and 4.13 (2.96-5.78) for those with ≥ 25 CPD.Limitations Smoking was self-reported and had some degree of measurement error. Participants were not a representative sample of the U.S. population.Conclusions Results from three large cohorts suggest a nonmonotonic dose-response association between smoking and suicide risk.
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Active smokers have about two to three times the risk of suicidality compared with people who never smoked.
“Although active smokers have been reported to have twofold to threefold increased risk of suicidality when compared to nonsmokers,1–4”
From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [7]
The Results report a pooled relative risk of 2.69 for completed suicide among current smokers compared with never smokers, supporting the stated twofold-to-threefold magnitude. The study measured suicide deaths, however, not suicidality more broadly, such as suicidal thoughts or attempts. (LLM, conf=0.84)
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- Authors
- Lucas, M., O’Reilly, E. J., Mirzaei, F., Okereke, O. I., Unger, L., Miller, M., & Ascherio, A.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 151
- Issue
- 3
- Pages
- 1053-1058
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC3881308
- OpenAlex
- W2063277089
- Cited by
- 43
- References
- 48
- Citations by year
- 2025: 5 · 2024: 4 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 5 · 2017: 5 · 2016: 5 · 2015: 5 · 2014: 3
- FWCI
- 4.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Nurses’ Health Study and Health
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- cigarette smoking, suicide, suicide risk, dose-response relationship, current smokers, former smokers, cigarettes per day, non-monotonic dose-response, Health Professionals Follow-up Study, Nurses' Health Study, Nurses' Health Study II
- MeSH terms
- Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Smoking, Suicide, United States, Cohort Studies, Proportional Hazards Models
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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